Acute intestinal ischaemia due to a foramen of Winslow hernia
- PDF / 699,372 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 68 Downloads / 165 Views
CE - MEDICAL ILLUSTRATION
Acute intestinal ischaemia due to a foramen of Winslow hernia Alexia Roux1 · Valentin David2 · Sylvaine Durand Fontanier3,4 · Muriel Mathonnet3 · Abdelkader Taibi1,3,4 Received: 23 January 2020 / Accepted: 7 March 2020 © Società Italiana di Medicina Interna (SIMI) 2020
A 57-year-old woman presented to the emergency department with a 1-day history of abdominal pain in the epigastric area, which had been associated with nausea. Laboratory test results were normal. Abdominal computed tomography (CT) findings were initially interpreted as normal. After 10 h, the patient developed epigastric guarding and a distended abdomen. A second interpretation of the abdominal CT findings revealed an internal hernia with an incarcerated loop behind the hepatic pedicle (Fig. 1a, b). Emergency exploratory laparoscopy confirmed the imaging findings. Laparotomy revealed internal herniation of the small intestine through the foramen of Winslow. After hernia reduction, multiple patchy areas of intestinal necrosis were observed (Fig. 1c) and 20 cm of ischaemic small intestine was resected (Fig. 1d). The patient was hospitalised for 4 days without complications. Her diet was restarted on the first postoperative day, because intestinal transit was restored. At the 5-month follow-up visit, she was asymptomatic and exhibited no evidence of recurrence. Blandin first described a foramen of Winslow hernia in 1834. Such hernias are rare, constituting up to 8% of internal hernias and 0.08% of all hernias [1, 2]. Although the symptoms of these hernias are typical of bowel obstruction, their diagnosis is difficult and can lead to delayed management with serious complications, such as bowel ischaemia or necrosis [3]. Foramen of Winslow hernias more frequently affect the small bowel (60–70%), followed by the caecum and ascending colon (25–30%) [4]. The key to diagnosis
* Abdelkader Taibi [email protected] 1
Digestive Surgery Department, Saint Junien Hospital, Saint Junien, France
2
Pharmacy Department, Dupuytren University Hospital, Limoges, France
3
Digestive Surgery Department, Dupuytren University Hospital, Limoges, France
4
University Limoges, CNRS, XLIM, UMR 7252, Limoges, France
relies on prompt CT, which is now considered the technique of choice and enables the surgeon to establish a proper diagnosis and consider an urgent laparoscopic approach. In conclusion, radiologists and gastrointestinal surgeons must be familiar with this rare hernia to prevent delays in diagnosis and treatment, with a high mortality rate.
Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest. Statement of human and animal rights All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent Written informed consent was obtained from the patient’s wife for being included in the study.
References 1. Grousseau D, Descottes
Data Loading...
